Fluid-assisted electrosurgical device

ABSTRACT

The disclosure provides a fluid-assisted electrosurgical device. The device comprises a first electrode, a second electrode and at least one fluid outlet. In one embodiment, the first electrode has a distal portion with an electrically conductive spherical surface, the second electrode has a distal portion with an electrically conductive spherical surface, and at least one of the first electrode and the second electrode have a blade portion.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a divisional of U.S. application Ser. No.12/710,791, filed Feb. 3, 2010, and entitled “Fluid-AssistedElectrosurgical Device”; which claims priority to U.S. provisionalapplication Ser. No. 61/154,623, filed Feb. 23, 2009, which areincorporated by reference herein to the extent it is consistent.

FIELD

This disclosure relates generally to the field of medical devices,systems and methods for use upon a human body during surgery. Moreparticularly, the disclosure relates to surgical devices, systems andmethods that provide cutting of tissue as well as coagulation,hemostasis and sealing of tissue to inhibit blood and other fluid lossduring surgery such as abdominal, orthopedic, spine and thoracic surgeryas well as general surgery of the body.

BACKGROUND

Fluid-assisted electrosurgical devices have been developed which, whenused in conjunction with an electrically conductive fluid such assaline, may be moved along a tissue surface, without cutting the tissue,to seal tissue to inhibit blood and other fluid loss during surgery.However, to cut tissue the surgeon must utilize a second device, whichnecessitates delays associated when switching between devices. What isstill needed is an electrosurgical device which is capable of cutting oftissue as well as providing fluid-assisted sealing of tissue to inhibitblood and other fluid loss during surgery, as well as inhibitundesirable effects of tissue desiccation, tissue sticking to theelectrode, tissue perforation, char formation and smoke generation.

SUMMARY

The disclosure, in one embodiment, may provide an electrosurgical deviceto treat tissue in a presence of a fluid from a fluid source andradio-frequency power from a radio-frequency power source, particularlyproviding a bipolar power output and a monopolar power output. Thedevice may comprise a distal portion comprising a first electrode tip, asecond electrode tip and at least one fluid outlet. The first and secondelectrode tips may be configured as bipolar electrodes, to receive thebipolar power output from the radio-frequency power source, and at leastone of the electrode tips may be configured as a monopolar electrode, toreceive the monopolar power output from the radio-frequency powersource.

In certain embodiments, the at least one electrode tip configured as amonopolar electrode may provide an electrosurgical cutting edge, whichmay be configured to cut tissue by moving along a tissue surface in apresence of monopolar power output provided from the distal portion.

In certain embodiments, the at least one electrode tip configured as amonopolar electrode may comprise a blade portion. The blade portion maycomprise opposing sides and an electrosurgical cutting edge. Theelectrosurgical cutting edge may extend from a proximal portion of theelectrode tip to a distal portion of the electrode tip. The bladeportion may narrow as the opposing sides approach the cutting edge.

In certain embodiments, at least one of the opposing sides may comprisea planar surface, concave surface or convex surface. Furthermore, theopposing sides may comprise opposing planer surfaces, concave surfacesor convex surfaces.

In certain embodiments, the first electrode tip and the second electrodetip may be configured to treat tissue by moving along a tissue surfacein a presence of a bipolar power output and a fluid providedsimultaneously from the distal portion.

In certain embodiments, the at least one fluid outlet may furthercomprise at least one fluid outlet in fluid communication with the firstelectrode tip, and at least one fluid outlet in fluid communication tothe second electrode tip. The at least one fluid outlet in fluidcommunication with the first electrode tip may be proximal to a distalend of the first electrode tip, and the at least one fluid outlet influid communication with the second electrode tip may be proximal to adistal end of the second electrode tip. The at least one fluid outlet influid communication with the first electrode tip may be at leastpartially defined by the first electrode tip, and the at least one fluidoutlet in fluid communication with the second electrode tip may be atleast partially defined by the second electrode tip. The at least onefluid outlet in fluid communication with the first electrode tip maycomprise a plurality of fluid outlets at least partially defined by thefirst electrode tip and the at least one fluid outlet in fluidcommunication with the second electrode tip may comprise a plurality offluid outlets at least partially defined by the second electrode tip.

In certain embodiments, the first electrode tip may be laterally spacedfrom the second electrode tip. The first electrode tip may have a bluntdistal end, and the second electrode tip may have a blunt distal end.The first electrode tip may also have a rounded distal end, and thesecond electrode tip may also have a rounded distal end. The firstelectrode tip and second electrode tip may be at a distal end of a shaftassembly.

In certain embodiments, an electrosurgical device to treat tissue in apresence of radio frequency energy and a fluid provided from the devicemay be provided, with the device comprising a distal portion comprisinga first electrode tip, a second electrode tip and at least one fluidoutlet. The first electrode tip may comprise a first electrode having adistal portion with an electrically conductive spherical surface, andthe second electrode tip may comprise a second electrode having a distalportion with an electrically conductive spherical surface. At least oneof the first electrode and the second electrode may have a bladeportion.

In certain embodiments, the first electrode and the second electrode maybe configured to be electrically coupled to a bipolar power output, andthe at least one electrode having the blade portion may be configured tobe electrically coupled to a monopolar power output. The blade portionmay extend longitudinally along the electrode, from a proximal portionto the distal portion of the electrode. The blade portion may have acutting edge, and more particularly have an electrosurgical cuttingedge. The blade portion may have opposing sides, and narrow as theopposing sides approach the cutting edge. At least one of the opposingsides may comprise a planar surface, a concave surface or a convexsurface.

In certain embodiments, the at least one fluid outlet may furthercomprise at least one fluid outlet in fluid communication with the firstelectrode and at least one fluid outlet in fluid communication with thesecond electrode. The at least one fluid outlet in fluid communicationwith the first electrode may be proximal to a distal end of the firstelectrode and at least partially defined by the first electrode, and theat least one fluid outlet in fluid communication with the secondelectrode may be proximal to a distal end of the second electrode and atleast partially defined by the second electrode.

In certain embodiments, the first electrode may be laterally spaced fromthe second electrode. The first electrode may be carried by a firsttubing segment at a distal end thereof, and the second electrode may becarried by a second tubing segment at a distal end thereof. The firstelectrode may be connected at a distal end of a first tubing segment,particularly mechanically joined to the first tubing segment, and thesecond electrode may be connected at a distal end of the second tubingsegment, particularly mechanically joined to the second tubing segment.The first electrode also may be welded to the first tubing segment, andthe second electrode may be welded to the second tubing segment.

In certain embodiments, the first tubing segment may be electricallyconductive and in electrical contact with the first electrode, and thesecond tubing segment may be electrically conductive and in electricalcontact with the second electrode.

In certain embodiments, an electrosurgical device having a distalportion comprising a first electrode tip, a second electrode tip and atleast one fluid outlet may be provided, with the first electrode tipcomprising a first electrode having a blade portion and the secondelectrode tip comprising a second electrode having a blade portion. Thefirst and second electrodes may be configured to be electrically coupledto a bipolar energy source and at least one of the electrodes may beconfigured to be electrically coupled to a monopolar energy source. Thefirst and second electrodes may be electrically coupled to the bipolarenergy source by first and second bipolar electrical connectors inelectrical communication with the first and second electrodes,respectively, and at least one of the electrodes may be electricallycoupled to the monopolar energy source by a monopolar electricalconnector in electrical communication with at least one of theelectrodes.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a front view of one embodiment of a system of the presentdisclosure having an electrosurgical unit in combination with a fluidsource and handheld electrosurgical device;

FIG. 2 a front perspective view of the electrosurgical unit of FIG. 1;

FIG. 3 is a graph of the bipolar RF power output versus impedance forthe electrosurgical unit of FIG. 1;

FIG. 4 is graph showing a relationship of fluid flow rate Q in units ofcubic centimetres per minute (cc/min) on the Y-axis, and the RF powersetting P_(S) in units of watts on the X-axis;

FIG. 5 is a perspective view of an electrosurgical device according tothe present disclosure;

FIG. 6A is a plan view showing the various electrical connections andconductors of the device of FIG. 5 with the electro surgical unit ofFIG. 1;

FIG. 6B is a plan view showing the various fluid connections andpassages of the device of FIG. 5 with the electrosurgical unit and fluidsource of FIG. 1;

FIG. 7 is a close-up view of the shaft assembly of the device of FIG. 5;

FIG. 8 is a close-up cross-sectional view of the electrodes of thedevice of FIG. 5 taken along line 8-8 of FIG. 7;

FIG. 9 is a close-up view of the shape of the electrodes of anotherembodiment of the device of FIG. 5 taken along line 8-8 of FIG. 7;

FIG. 10 is a close-up view of the shape of the electrodes of anotherembodiment of the device of FIG. 5 taken along line 8-8 of FIG. 7;

FIG. 11 is a close-up cross-sectional view of a distal end portion ofthe device of FIG. 5 taken perpendicular to line 8-8 of FIG. 7;

FIG. 12 is a close-up view of a distal end portion of the device of FIG.5 with an exemplary fluid coupling to a tissue surface of tissue; and

FIG. 13 is a perspective view of the device of FIG. 5 cutting tissue.

DETAILED DESCRIPTION

Throughout the description, like reference numerals and letters indicatecorresponding structure throughout the several views. Also, anyparticular feature(s) of a particular exemplary embodiment may beequally applied to any other exemplary embodiment(s) of thisspecification as suitable. In other words, features between the variousexemplary embodiments described herein are interchangeable as suitable,and not exclusive. From the specification, it should be clear that anyuse of the terms “distal” and “proximal” are made in reference from theuser of the device, and not the patient.

The disclosure provides devices, systems and methods for controllingtissue temperature at a tissue treatment site during an electrosurgicalprocedure, as well as shrinking, coagulating, cutting and sealing tissueagainst blood loss, for example, by shrinking lumens of blood vessels(e.g., arteries, veins).

The disclosure will now be discussed with reference to the figures, withFIG. 1 showing a front view of one embodiment of a system of the presentdisclosure having an exemplary electrosurgical unit 10 in combinationwith a fluid source 20 and a handheld electrosurgical device 30. FIG. 1shows a movable cart 2 having a support member 4 comprising a hollowcylindrical post which carries a platform 6 comprising a pedestal tableto provide a flat, stable surface for location of the electrosurgicalunit 10.

As shown, cart 2 further comprises a fluid source carrying pole 8 havinga height which may be adjusted by sliding the carrying pole 8 up anddown within the support member 4 and thereafter secured in position witha set screw. On the top of the fluid source carrying pole 8 is a crosssupport provided with loops at the ends thereof to provide a hook forcarrying fluid source 20.

As shown in FIG. 1, fluid source 20 comprises a bag of fluid from whichthe fluid 12 flows through a drip chamber 14 after the bag is penetratedwith a spike located at the end of the drip chamber 14. Thereafter,fluid 12 flows through flexible delivery tubing 16 to handheldelectrosurgical device 30. Preferably the fluid delivery tubing 16 ismade from a polymer material.

As shown in FIG. 1, the fluid delivery tubing 16 passes through pump 22.As shown pump 22 comprises a peristaltic pump and, more specifically, arotary peristaltic pump. With a rotary peristaltic pump, a portion ofthe delivery tubing 16 is loaded into the pump head by raising and lowerthe pump head in a known manner. Fluid 12 is then conveyed within thedelivery tubing 16 by waves of contraction placed externally on thetubing 16 which are produced mechanically, typically by rotating pinchrollers which rotate on a drive shaft and intermittently compress thetubing 16 against an anvil support. Peristaltic pumps are generallypreferred, as the electro-mechanical force mechanism, here rollersdriven by electric motor, does not make contact the fluid 12, thusreducing the likelihood of inadvertent contamination.

In the present embodiment the fluid 12 comprises saline solution, andeven more specifically, normal (physiologic) saline. Although thedescription herein may make reference to saline as the fluid 12, otherelectrically conductive fluids can be used in accordance with thedisclosure.

While an electrically conductive fluid having an electricallyconductivity similar to normal saline is preferred, as will become moreapparent with further reading of this specification, fluid 12 may alsocomprise an electrically non-conductive fluid. The use of anon-conductive fluid, while not providing all the advantage of anelectrically conductive fluid, still provides certain advantages overthe use of a dry electrode including, for example, reduced occurrence oftissue sticking to the electrode of device 30 and cooling of theelectrode and/or tissue. Therefore, it is also within the scope of thedisclosure to include the use of a non-conducting fluid, such as, forexample, deionized water.

Electrosurgical unit 10 is configured to provide both monopolar andbipolar power output. However, electrosurgical unit 10 includes a lockout feature which prevents both monopolar and bipolar output from beingactivated simultaneously. Alternatively, rather than use a singleelectrosurgical unit 10, device may be simultaneously connected to twoseparate electro surgical units. For example, device 30 may be connectedto a first electrosurgical unit to provide monopolar power output and asecond electrosurgical unit to provide bipolar power output.

During monopolar operation, a first electrode, often referred to as theactive electrode, is provided with the monopolar electrosurgical devicewhile a second electrode, often referred to as the indifferent orneutral electrode, is provided in the form of a ground pad dispersiveelectrode located on the patient (also known as a patient returnelectrode), typically on the back or other suitable anatomical location.An electrical circuit is formed between the active electrode and groundpad dispersive electrode with electrical current flowing from the activeelectrode through the patient to ground pad dispersive electrode in amanner known in the art. During bipolar operation, the ground padelectrode located on the patient is not required, and a second electrodeproviding an electrical pole is provided as part of the device. Analternating current electrical circuit is then created between the firstand second electrical poles of the device. Consequently, alternatingcurrent no longer flows through the patient's body to the ground padelectrode, but rather through a localized portion of tissue between thepoles of the bipolar device. Monopolar and bipolar power may be providedfrom electrosurgical unit 10 as known in the art, or from separateelectrosurgical units.

As shown in FIG. 1, electrosurgical device 30 is connected toelectrosurgical unit 10 via electrical cables 24 and 26. Cable 24 has aplug 34 which connects to bipolar mode output receptacle 38 ofelectrosurgical unit 10. Cable 26 has a plug 42 which connects to themonopolar mode output receptacle 46 of electrosurgical unit 10. As shownin FIG. 6A, when electrosurgical 10 is used in monopolar mode, anadditional cable 28 is utilized to connect a ground pad dispersiveelectrode 48 to the ground pad receptacle 56 of the electrosurgical unit10.

FIG. 2 shows the front panel of the exemplary electrosurgical unit 10. Apower switch 58 may be used to turn the electrosurgical unit 10 on andoff. After turning the electrosurgical unit 10 on, an RF power settingdisplay 60 may be used to display the RF power setting numerically inwatts. The power setting display 60 may further comprise a liquidcrystal display (LCD).

Electrosurgical unit 10 may further comprise an RF power selector 62comprising RF power setting switches 62 a, 62 b which may be used toselect the RF power setting. Pushing the switch 62 a may increase the RFpower setting, while pushing the switch 62 b may decrease the RF powersetting. RF power output may be set in 5 watt increments in the range of20 to 100 watts, and 10 watt increments in the range of 100 to 200watts. Additionally, electrosurgical unit 10 may include an RF poweractivation display 64 comprising an indicator light which may illuminatewhen RF power is activated, either via a handswitch on device 30 or afootswitch. Switches 62 a, 62 b may comprise membrane switches. Itshould be understood that while only one RF power selector 62 is shown,electrosurgical unit 10 will have two such RF power selectors with oneeach for monopolar and bipolar power selection.

In addition to having a RF power setting display 60, electrosurgicalunit 10 may further include a fluid flow rate setting display 66. Flowrate setting display 66 may comprise three indicator lights 66 a, 66 band 66 c with first light 66 a corresponding to a fluid flow ratesetting of low, second light 66 b corresponding to a fluid flow ratesetting of medium (intermediate) and third light 66 c corresponding to aflow rate setting of high. One of these three indicator lights willilluminate when a fluid flow rate setting is selected.

Electrosurgical unit 10 may further include a fluid flow selector 68comprising flow rate setting switches 68 a, 68 b and 68 c used to selector switch the flow rate setting. Three push switches may be providedwith first switch 68 a corresponding to the fluid flow rate setting oflow, second switch 68 b corresponding to a fluid flow rate setting ofmedium (intermediate) and third switch 68 c corresponding to a flow ratesetting of high. Pushing one of these three switches may select thecorresponding flow rate setting of either low, medium (intermediate) orhigh. The medium, or intermediate, flow rate setting may beautomatically selected as the default setting if no setting is manuallyselected. Switches 68 a, 68 b and 68 c may comprise membrane switches.

Before starting a surgical procedure, it may be desirable to primedevice 30 with fluid 12. Priming may be desirable to inhibit RF poweractivation without the presence of fluid 12. A priming switch 70 may beused to initiate priming of device 30 with fluid 12. Pushing switch 70once may initiate operation of pump 22 for a predetermined time periodto prime device 30. After the time period is complete, the pump 22 mayshut off automatically. When priming of device 30 is initiated, apriming display 72 comprising an indicator light may illuminate duringthe priming cycle.

An exemplary bipolar RF power output curve of electrosurgical unit 10 isshown in FIG. 3. Impedance Z, shown in units of ohms on the X-axis andoutput power P_(O) is shown in units of watts on the Y-axis. In theillustrated embodiment, the bipolar electrosurgical power (RF) is set to200 watts. As shown in the figure, for an RF power setting P_(S) of 200watts, the output power P_(O) will remain constant with the set RF powerPS as long as the impedance Z stays between the low impedance cut-off of30 ohms and the high impedance cut-off of 120 ohms. Below an impedance Zof 30 ohms, the output power P_(O) will decrease as shown by the lowimpedance ramp. Above an impedance Z of 120 ohms, the output power P_(O)will also decrease as shown by the high impedance ramp. With respect tomonopolar power output, an exemplary monopolar RF power output curvewould include that of the Valleylab Force FX, hereby incorporated byreference.

Electrosurgical unit 10 may be configured such that the speed of pump22, and therefore the throughput of fluid 12 expelled by the pump 22, ispredetermined based on two input variables, the RF power setting and thefluid flow rate setting. In FIG. 4 there is shown an exemplaryfunctional relationship of fluid flow rate Q in units of cubiccentimetres per minute (cc/min) on the Y-axis, and the RF power settingP_(S) in units of watts on the X-axis. The relationship may beengineered to inhibit undesirable effects such as tissue desiccation,electrode sticking, smoke production and char formation, while at thesame time not providing a fluid flow rate Q at a corresponding RF powersetting P_(S) which is so great as to provide too much electricaldispersion and cooling at the electrode/tissue interface. While notbeing bound to a particular theory, a more detailed discussion on howthe fluid flow rate interacts with the radio frequency power, modes ofheat transfer away from the tissue, fractional boiling of the fluid andvarious control strategies may be found in U.S. Publication No.2001/0032002, published Oct. 18, 2001, assigned to the assignee of thepresent disclosure and hereby incorporated by reference in its entiretyto the extent it is consistent.

As shown in FIG. 4, electrosurgical unit 10 has been configured toincrease the fluid flow rate Q linearly with an increasing RF powersetting P_(S) for each of three fluid flow rate settings of low, mediumand high corresponding to Q_(L), Q_(M) and Q_(H), respectively.Conversely, electrosurgical unit 10 has been configured to decrease thefluid flow rate Q linearly with a decrease RF power setting P_(S) foreach of three fluid flow rate settings of low, medium and highcorresponding to Q_(L), Q_(M) and Q_(H), respectively.

An electrosurgical unit similar to exemplary electrosurgical unit 10 andhaving detailed schematic drawings, albeit without monopolar output, maybe found in U.S. Publication No. 2006/0149225, published Jul. 6, 2006,assigned to the assignee of the present disclosure and herebyincorporated by reference in its entirety to the extent it isconsistent.

While electrosurgical unit 10 as shown above includes an attached pump22, in other embodiments pump 22 may not be integrated withelectrosurgical unit 10, but rather be separate from electrosurgicalunit 10.

In still other embodiments, pump 22 may be eliminated and there may beno preset functional relationship of fluid flow rate Q versus RF powersetting P_(S) stored in the electrosurgical unit 10. In such aninstance, rather than the fluid flow rate Q being automaticallycontrolled by the electrosurgical unit 10 based on the RF power settingP_(S), the fluid flow rate Q may be manually controlled, such as by theuser of device 10 or another member of the surgical team, with a roller(pinch) clamp or other clamp provided with device 10 and configured toact upon and compress the tubing 16 and control flow in a manner knownin the art. Exemplary fluid flow control mechanisms may be found in U.S.Publication No. 2005/0090816, published Apr. 28, 2005, assigned to theassignee of the present disclosure and hereby incorporated by referencein its entirety to the extent it is consistent. An example of anelectrosurgical unit which does not include a pump, but may be used inconjunction with a manually operated fluid flow control mechanism ondevice 10, includes an electrosurgical unit such as the Valleylab ForceFX.

An exemplary bipolar and/or monopolar electrosurgical device of thepresent disclosure which may be used in conjunction with electrosurgicalunit 10 of the present disclosure is shown at reference character 30 ain FIG. 5. While various electrosurgical devices of the presentdisclosure are described herein with reference to use withelectrosurgical unit 10, it should be understood that the description ofthe combination is for purposes of illustrating the system of thedisclosure. Consequently, it should be understood that while theelectrosurgical devices disclosed herein may be disclosed for use withelectrosurgical unit 10, it may be plausible to use otherelectrosurgical devices with electrosurgical unit 10, or it may beplausible to use the electrosurgical devices disclosed herein withanother electrosurgical unit.

As shown in FIG. 5, exemplary device 30 a comprises an elongated handle100 comprising mating handle portions 100 a, 100 b. Handle 100 isslender, along with the rest of device 30 a, to enable a user of device30 a to hold and manipulate device 30 a between the thumb and indexfinger like a pen-type device. Handle 100 may comprise a sterilizable,rigid, non-conductive material, such as a polymer (e.g., polycarbonate).

As best shown in FIG. 6A, device 30 a also comprises cables 24 and 26which are connectable to electrosurgical unit 10 to provide device 30 awith bipolar and monopolar power output, respectively, fromelectrosurgical unit 10. As shown, cable 24 of device 30 a comprisesthree insulated wire conductors 32 a, 32 b, 32 c connectable to bipolarpower output receptacles 38 a, 38 b, 38 c of electrosurgical unit 10 viathree banana (male) plug connectors 36 a, 36 b, 36 c. The banana plugconnectors 36 a, 36 b, 36 c are each assembled with insulated wireconductors 32 a, 32 b, 32 c within the housing of plug 34 in a knownmanner. On device 30 a, insulated wire conductor 32 a is connected to abipolar hand switch assembly 104, and insulated wire conductors 32 b and32 c are connected to semi-circular barrel crimp terminals which snapconnect to a proximal portion of shafts 106 a, 106 b of shaft assembly108.

Cable 26 of device 30 a comprises two insulated wire conductors 40 a, 40b connectable to monopolar power output receptacles 46 a, 46 b ofelectrosurgical unit 10 via two banana (male) plug connectors 44 a, 44b. The banana plug connectors 44 a, 44 b are each assembled withinsulated wire conductors 40 a, 40 b within the housing of plug 42 in aknown manner. On device 30 a, insulated wire conductor 40 a is connectedto a monopolar hand switch assembly 110, and insulated wire conductor 40b is connected to a semi-circular barrel crimp terminal which snapconnects to a proximal portion of shaft 106 b of shaft assembly 108.When device 30 a is used in monopolar mode, an additional cable 28 isutilized to connect a ground pad dispersive electrode 48 which isattached to the patient to the electrosurgical unit 10 comprising wireconductor 50 and plug 52 at the end thereof having plug connector 54which connects to the ground pad receptacle 56. As shown wire conductors32 b and 40 b merge inside handle 100 and share the same attachmentlocation to shaft 106 b.

Hand switch assemblies 104 and 110 may comprise push buttons 114 and116, respectively, (best shown in FIG. 5) which overlie domed switcheson a platform comprising a printed circuit board, with the constructionand wiring of the hand switch assemblies 104 and 110 known in the art.Upon depression of push buttons 114 or 116, a domed switch beneath thepush button forms a closed circuit which is sensed by electrosurgicalunit 10, which then provides bipolar or monopolar power, respectively.Exemplary hand switches may be found in U.S. Publication No.2006/0149225, published Jul. 6, 2006, and U.S. Publication No.2005/0090816, published Apr. 28, 2005, which are assigned to theassignee of the present disclosure and are hereby incorporated byreference in there entirety to the extent they are consistent.

As shown FIG. 6B, during use of device 30 a, fluid 12 from fluid source20 is communicated through a tubular fluid passage which provided byvarious structures. In the present embodiment, fluid 12 from the fluidsource 20 is first communicated through lumen 18 of delivery tubing 16.Fluid 12 may also flow through lumen 120 of a special pump tubingsegment 118 designed to operate specifically with the peristaltic pump22, which may be spliced in between portions of delivery tubing 16 andconnected thereto using barbed fluid line connectors 122 at each endthereof.

Within handle 100 of device 30 a, fluid delivery tubing 16 is connectedto the inlet branch of a Y-splitter 124, which thereafter provides twooutlet branches which are connected to the proximal ends of polymerdelivery tubing segments 128 a, 128 b. The distal ends of deliverytubing segments 128 a, 128 b are thereafter connected to the proximalends of shafts 106 a, 106 b. To connect delivery tubing 128 a, 128 b toshafts 106 a, 106 b, the lumens 130 a, 130 b are preferably interferencefit over the outside diameter of shafts 106 a, 106 b to provide aninterference fit seal there between. Fluid 12 then may flow through thelumens 134 a, 134 b of shafts 106 a, 106 b.

Once the semi-circular barrel crimp terminals and delivery tubingsegments 128 a, 128 b are connected to shafts 106 a, 106 b, a polymershrink wrap tubing may then be heat shrink wrapped around theconnections to better electrically insulate the shafts 106 a, 106 b andbetter secure the connections.

As best shown in FIG. 7, shaft assembly 108 of the present embodimentcomprises two parallel, self-supporting, electrically conductive hollowshafts 106 a, 106 b, which comprise metal tubing segments, such asstainless steel tubing segments. Carried by and connected to the distalends of shafts 106 a, 106 b are two laterally and spatially separated(by empty space) contact elements in the form of electrode tipscomprising electrodes 102 a, 102 b which may be configured as mirrorimages in size and shape, and have a blunt distal end with a surfacedevoid of edges (to provide a uniform current density) to treat tissue.In the present embodiment electrodes 102 a, 102 b comprise anelectrically conductive material, particularly metal, such as stainlesssteel. Other suitable materials may include titanium, gold, silver andplatinum.

In certain embodiments, the tubing segments of one or both shafts 106 a,106 b may be made of electrically non-conducting material except for theportion at the distal end that comes in physical and electrical contactwith electrodes 102 a, 102 b. In these embodiments, an insulated wireconductor would extend and be joined to the electrically conductingportion of shaft 106 a, 106 b. In still other embodiments, shafts 106 a,106 b may completely comprise electrically non-conducting material, inwhich case an insulated wire conductor would extend and be joineddirectly to electrodes 102 a, 102 b.

As shown in FIG. 7, each electrode 102 a, 102 b comprises an elongatedportion 138 a, 138 b. With respect to length, in the present embodimentelongated portion 138 a, 138 b has a length in the range between andincluding about 2 mm to 6 mm, and more specifically have a length ofabout 3 mm to 5 mm. With respect to spacing, in the present embodimentthe spatial gap separation GS between electrodes 102 a, 102 b in therange between and including about 0.1 mm to about 4 mm, and morespecifically about 1 mm to 2.5 mm, and more specifically about 1.5 mm to2.3 mm.

As best shown in FIG. 8, opposing sides 140 a/142 a of elongated portion138 a, and opposing sides 140 b/142 b of elongated portion 138 bconverge laterally to provide a wedge shaped blade portion 144 a, 144 bwhich terminates in a lateral cutting edge 146 a, 146 b which extendslongitudinally along a length of each electrode 102 a, 102 b. As shownin FIG. 8, lateral cutting edge 146 a, 146 b extends from a proximal todistal portion of each electrode 102 a, 102 b, as well as transitionsonto the distal end of each electrode 102 a, 102 b and forms a portionof the distal end of each electrode 102 a, 102 b.

Lateral cutting edge 146 a, 146 b is preferably configured to cut tissueelectrosurgically in the presence of monopolar radio frequency energyfrom electrosurgical unit 10 as to provide an electrosurgical cuttingedge, but without any fluid 12 being provided from fluid source 20.However, in other embodiments, lateral cutting edge 146 a, 146 b may beconfigured to cut tissue with fluid 12 being provided simultaneouslyfrom device 30 a, or be configured to cut tissue mechanically withoutelectrosurgical energy. Furthermore, while two cutting edges 146 a, 146b are shown, only one of the edges 146 a or 146 b needs to be configuredto cut tissue electrosurgically or mechanically. In such instance, theblade portion of the electrode may be eliminated and the elongatedportion may be completely cylindrical.

As shown in FIG. 8, blade portion 144 a, 144 b narrows as the opposingsides 140 a/142 a and 140 b/142 b approach cutting edge 146 a, 146 b.More particularly, as shown in FIG. 8, the sides 140 a/142 a and 140b/142 b of blade portion 144 a, 144 b are concave. However, in otherembodiments, sides 140 a/142 a and 140 b/142 b may be planar or convexas shown in FIGS. 9 and 10, respectively. Also, in other embodiments,only one of sides 140 a/142 a and 140 b/142 b may be concave, planar orconvex.

Returning to FIG. 7, electrodes 102 a, 102 b and elongated portions 138a, 138 b terminate in distal end portion 148 a, 148 b. The distal endportion 148 a, 148 b of electrodes 102 a, 102 b are configured to slideacross a tissue surface in the presence of bipolar radio frequencyenergy from electrosurgical unit 10 and fluid 12 from the fluid source20. As shown, the distal end portion 148 a, 148 b of each electrode 102a, 102 b has a blunt, rounded shape which provides a smooth contoursurface which is devoid of points or edges. More specifically, as shown,distal end portion 148 a, 148 b of each electrode 102 a, 102 b has aspherical surface provided by spherical portion 150 a, 150 b. In thepresent embodiment, spherical portion 150 a, 150 b has a radius in therange between and including about 0.5 mm to 1.5 mm, and morespecifically about 0.75 mm to 1.15 mm.

As best shown in FIGS. 8 and 11, within a cylindrical portion 152 a, 152b of each electrode 102 a, 102 b proximal to distal end portion 148 a,148 b, each electrode 102 a, 102 b includes a longitudinally orientedlinear blind bore 158 a, 158 b and counter bore 160 a, 160 b. As shownin FIG. 11, the outside diameter of a distal end portion of each shaft106 a, 106 b is configured to extend into counter bore 160 a, 160 b ofelectrodes 102 a, 102 b and fit with the diameter of counter bore 160 a,160 b, with the distal end of each shaft 106 a, 106 b in contact withthe bottom of the counter bore. The electrodes 102 a, 102 b and shafts106 a, 106 b may then be welded together to connect the two components.In alternative embodiments, the outside diameter of shafts 106 a, 106 bmay be configured to fit with the diameter of counter bore 160 a, 160 band mechanically join in the form of a press (interference) fit toprovide a secure connection. In other alternative embodiments,electrodes 102 a, 102 b may be assembled to shafts 106 a, 106 b bythreaded engagement. In still other embodiments, electrodes 102 a, 102 bmay be detachably assembled to shafts 106 a, 106 b such that they may beremoved from the shafts 106 a, 106 b, preferably manually by human hand.

In addition to blind bore 158 a, 158 b and counterbore 160 a, 160 b, asshown in FIG. 8, electrodes 102 a, 102 b also include a through bores162 a/164 a and 162 b/164 b which perpendicularly intersects bore 158 a,158 b and perpendicularly intersect one another to provide outlets 166a/168 a/170 a/172 a and 166 b/168 b/170 b/172 b (for fluid 12) which arein fluid communication with electrodes 102 a, 102 b. Thus, after fluid12 flows through the lumens 134 a, 134 b of shafts 106 a, 106 b, fluid12 then flows through into the tubular passage provided by blind bore158 a, 158 b and then into the tubular passage provided by through bores162 a/164 a and 162 b/164 b where it thereafter exits device 30 a fromfluid outlets 166 a/168 a/170 a/172 a and 166 b/168 b/170 b/172 b, whichare all proximal to distal end portion 148 a, 148 b of electrodes 102 a,102 b. As shown in FIG. 8, fluid outlets 166 a/170 a and 166 b/170 b areat least partially defined by the cylindrical portion 152 a, 152 b ofelectrodes 102 a, 102 b, while fluid outlets 168 a/172 a and 168 b/172 bare at least partially defined by sides of 140 a/142 a and 140 b/142 bof blade portion 144 a, 144 b and adjacent cutting edge 146 a, 146 b.More particularly, as shown in FIG. 8, fluid outlets 166 a/170 a and 166b/170 b are fully defined by the cylindrical portion 152 a, 152 b ofelectrodes 102 a, 102 b, while fluid outlets 168 a/172 a and 168 b/172 bare fully defined by sides of 140 a/142 a and 140 b/142 b of bladeportion 144 a, 144 b and adjacent cutting edge 146 a, 146 b. In certainembodiments, each electrode 102 a, 102 b may have only one fluid outletin fluid communication therewith, such as outlets 168 a, 168 b. In stillother embodiments, only a single one fluid outlet may be present.

The relationship between the material for electrodes 102 a, 102 b andtheir surfaces, and fluid 12 throughout the various embodiments shouldbe such that the fluid 12 wets the surface of the electrodes 102 a, 102b. Contact angle, .theta., is a quantitative measure of the wetting of asolid by a liquid. It is defined geometrically as the angle formed by aliquid at the three phase boundary where a liquid, gas and solidintersect. In terms of the thermodynamics of the materials involved,contact angle .theta. involves the interfacial free energies between thethree phases given by the equation.gamma..sub.LV cos .theta.=.gamma..sub.SV-.gamma..sub.SLwhere .gamma..sub.LV, .gamma..sub.SV and .gamma..sub.SL refer to theinterfacial energies of the liquid/vapor, solid/vapor and solid/liquidinterfaces, respectively. If the contact angle .theta. is less than 90degrees the liquid is said to wet the solid. If the contact angle isgreater than 90 degrees the liquid is non-wetting. A zero contact angle.theta. represents complete wetting. Thus, preferably the contact angleis less than 90 degrees.

As best shown in FIGS. 7 and 11, a portion of the lengths of shafts 106a, 106 b are surrounded by and encapsulated in a common outer member184, which may comprises a flexible polymer. Outer member 184electrically insulates the exposed length of shafts 106 a, 106 b.

Outer member 184 may be formed by injection molding. During theinjection molding process, a sub-assembly comprising electrodes 102 a,102 b and shafts 106 a, 106 b is placed in the injection mold prior tothe introduction of polymer. Thereafter, the mold is closed and athermoplastic polymer may be injected into the unoccupied portions ofthe mold cavity to overmold and mold-in place portions of thesub-assembly as shown in FIG. 7. During the injection molding process,retainer clips (not shown) may provide the benefit of retaining shafts106 a, 106 b in position relative to each other to better ensure thatthe shafts 106 a, 106 b are centrally located within the polymermolding.

To be hand shapeable by surgeons and other users of device 30 a, so thatthe device 30 a may be used in a greater multitude of angles andlocations, at least a portion of shafts 106 a, 106 b of device 30 a maybe malleable to provide a malleable shaft assembly 108. Also, in thismanner, a distal portion of shafts 106 a, 106 b may be bendable at anangle relative to the longitudinal axis of the proximal portion ofshafts 106 a, 106 b during manufacturing of device 30 a so they may beprovided to users of device 30 a at various angles. For example, anglemay range from about 5 degrees to 90 degrees, and more preferably, about15 degrees to 45 degrees, and even more preferably about 30 degrees. Asused herein, malleable means able to be shaped, particularly by bending(without a mechanical mechanism, such as a hinge or joint). It should beunderstood that shaft assembly 108 is to independently maintain theshape associated with the selected bent shape, and does not requireadditional components (e.g., pull wires, etc.) to maintain the selectedbent shape. Furthermore, shaft assembly 108 is to maintain the selectedshape such that when device 30 a is used to treat tissue, and will notovertly deflect from the selected shape. Furthermore, shaft assembly 108is constructed such that a user can readily re-shape the shafts back toa straight state and/or other desired bent configurations.

Outer member 184, in addition to electrically insulating shafts 106 a,106 b from one another, has been found to be particularly useful infacilitating the hand shaping of shafts 106 a, 106 b of shaft assembly108 simultaneously and with a similar contour without cracking. In thismanner, surgeons and other users of device 30 a need not bend the shafts106 a, 106 b individually, and the relative spacing and position of theelectrodes 102 a, 102 b may be maintained constant.

To provide malleability, shafts 106 a, 106 b preferably have an outerwall diameter of about 0.063 inches and an inner wall diameter of about0.032 inches. Shafts 106 a, 106 b also preferably are made from 304stainless steel with a temper from about ½ to ¾ hard, 130,000 to 150,000psi. (pounds per square inch) tensile strength) and an elongation atbreak of about 40%. Shafts 106 a, 106 b with the foregoing propertiesprovide sufficient stiffness as not to be too pliable during normal useof device 30 a, while at the same time inhibiting the shafts 106 a, 106b from kinking or breaking when shaped for application. When the wallthickness is too thin, shafts 106 a, 106 b may kink, and when the wallthickness is too thick, the shafts 106 a, 106 b may be too stiff.Furthermore, a shaft 106 a, 106 b with a larger diameter may also kinkmore than a shaft of smaller diameter. Shafts 106 a, 106 b may also bemalleable for a portion of the length or full length depending onapplication. For example, the shafts 106 a, 106 b can be made withvariable stiffness along the length and be malleable only for a distalportion thereof. Preferably this is performed by controlled annealing ofthe shafts 106 a, 106 b only in the area where malleability is desired.

As shown in FIG. 12, one way in which device 30 a may be used is withthe longitudinal axis of electrodes 102 a, 102 b vertically orientated,and the distal end portion 148 a, 148 b of electrodes 102 a, 102 blaterally spaced adjacent tissue surface 202 of tissue 200. When device30 a is used in this manner, electrodes 102 a, 102 b are connected toelectrosurgical unit 10 and receive bipolar radio frequency energy whichforms an alternating current electrical field in tissue 200 locatedbetween electrodes 102 a, 102 b. In the presence of alternating current,the electrodes 102 a, 102 b alternate polarity between positive andnegative charges with current flow from the positive to negative charge.Without being bound to a particular theory, heating of the tissue isperformed by electrical resistance heating.

Fluid 12, in addition to providing an electrical coupling between thedevice 30 a and tissue 200, lubricates surface 202 of tissue 200 andfacilitates the movement of electrodes 102 a, 102 b across surface 202of tissue 200. During movement of electrodes 102 a, 102 b, electrodes102 a, 102 b typically slide across the surface 202 of tissue 200.Typically the user of device 30 a slides electrodes 102 a, 102 b acrosssurface 202 of tissue 200 back and forth with a painting motion whileusing fluid 12 as, among other things, a lubricating coating. Preferablythe thickness of the fluid 12 between the distal end portions 148 a, 148b of electrodes 102 a, 102 b and surface 202 of tissue 200 at the outeredge of couplings 204 a, 204 b is in the range between and includingabout 0.05 mm to 1.5 mm. Also, in certain embodiments, the distal endportion 148 a, 148 b of electrodes 102 a, 102 b may contact surface 202of tissue 200 without any fluid 12 in between.

As shown in FIG. 12, fluid 12 expelled from fluid outlets may form intodroplets 208 a, 208 b which flow distally on electrodes 102 a, 102 b. Asshown in FIG. 12, droplets 208 a, 208 b may form at varying times fromfluid 12 expelled from any one of the fluid outlets. Also, fluid 12 maybe expelled in varying quantity from each of the fluid outlets,depending on, for example, device orientation, pressure, flow rate andvarying fluid outlet sizes. With use of device 30 a, the size ofdroplets 208 a, 208 b may also vary due to changes in the surface finishof the electrodes 102 a, 102 b, for example, as a result of beingcontaminated by blood and tissue.

As shown in FIG. 12, fluid couplings 204 a, 204 b comprise discrete,localized webs and more specifically comprise triangular shaped webs orbead portions providing a film of fluid 12 between surface 202 of tissue200 and electrodes 102 a, 102 b. When the user of electrosurgical device30 a places electrodes 102 a, 102 b at a tissue treatment site and moveselectrodes 102 a, 102 b across the surface 202 of the tissue 200, fluid12 is expelled from fluid outlets 166 a/168 a/170 a/172 a and 166 b/168b/170 b/172 b around the surfaces of electrodes 102 a, 102 b and ontothe surface 202 of the tissue 200 via couplings 204 a, 204 b. At thesame time, RF electrical energy, shown by electrical field lines 206, isprovided to tissue 200 at tissue surface 202 and below tissue surface202 into tissue 200 through fluid couplings 204 a, 204 b. As shown inFIG. 13, device 30 a may be used to cut tissue by applying eithercutting edge 146 a or 146 b to tissue 200, depending which electrode 102a, 102 b is utilized, and repeatedly moving the electrode 102 a or 102 balong a desired incision or resection line in the tissue to form thedepicted crevice.

Device 30 a may be used to perform a solid organ resection such as aliver resection. Edge 146 a or 146 b may be first used to score theouter capsule of the liver along the planned line of resection.Thereafter, the distal end portions 148 a, 148 b of electrodes 102 a,102 b may be moved back and forth along the line, with radio frequencypower and the flow of fluid on, resulting in coagulation of the liverparenchyma beneath the scored capsule. As the tissue is coagulated underand around the electrode surfaces, the electrodes 102 a, 102 b may beused to separate and blunt dissect the coagulated parenchyma and enterthe resulting crevice. As the distal end portions 148 a, 148 b ofelectrodes 102 a, 102 b treat the parenchyma, the treated parenchymalooses integrity and becomes easier to separate, either alone or inconjunction with separation force applied by electrodes 102 a, 102 bfrom the user of the device.

Blunt dissection of the coagulated parenchyma is performed by continuousabrading or splitting apart of the parenchyma with substantially thesame back and forth motion as coagulation and with the device 30 a beingheld substantially in the same orientation as for coagulation of theliver parenchyma. However, with blunt dissection, the surgeon typicallyapplies more force to the tissue. In various embodiments, once the liverparenchyma is coagulated, blunt dissection may be performed with orwithout the radio frequency power (i.e., on or off) and/or with orwithout the presence of fluid from device 30 a. Additionally oralternatively, the tissue on opposing sides of the line of resection maybe placed into tension perpendicular to the line of resection tofacilitate resection. Furthermore, resection may also be accomplished bysharp dissection with edge 146 a or 146 b of electrodes 102 a, 102 b.Thus, with device 30 a, a surgeon may perform a resection procedure in anumber of different ways.

As the parenchyma is resected, blood vessels within the parenchyma maybe uncovered which extend across or transverse the line of resection.Device 30 a may be used to shrink and seal these vessels by heating andshrinking the collagen contained in the walls of the vessels thusdecreasing the diameter of the lumen of these vessels. For vessels witha diameter too large to completely occlude the lumen, the vessels may betied with suture on each side of the line of resection and thereaftersevered therebetween. If such vessels are not first uncovered byremoving the surrounding parenchyma tissue and without being severed,they may bleed profusely and require much more time to stop thebleeding. Consequently, it may be desirable to avoid separation by sharpdissection in situations where large vessels are not first uncovered andexposed.

This technique can also be used on other parenchymal organs such as thepancreas, the kidney, and the lung. In addition, it may also be usefulon muscle tissue and subcutaneous fat. It's use can also extend totumors, cysts or other tissue masses found in the urological orgynecological areas. It would also enable the removal of highlyvascularized tumors such as hemangiomas.

The devices disclosed herein are particularly useful as non-coaptivedevices that provide cutting of tissue, as well as coagulation,hemostasis and sealing of tissue to inhibit blood and other fluid lossduring surgery. In other words, grasping of the tissue is not necessaryto shrink, coagulate, cut and seal tissue against blood loss, forexample, by shrinking collagen and associated lumens of blood vessels(e.g., arteries, veins) to provided the desired hemostasis of thetissue. Furthermore, the control system of the electrosurgical unit 10is not necessarily dependent on tissue feedback such as temperature orimpedance to operate. Thus, the control system of electrosurgical unit10 may be open loop with respect to the tissue which simplifies use.

Device 30 a disclosed herein may be particularly useful to surgeons toachieve hemostasis after cutting through soft tissue, as part of hip orknee arthroplasty. The distal end portions 148 a, 148 b can be paintedover the raw, oozing surface 202 of tissue 200 to seal the tissue 200against bleeding, or focused on individual larger bleeding vessels tostop vessel bleeding. As part of the same or different procedure, device30 a is also useful to stop bleeding from the surface of cut bone, orosseous, tissue as part of any orthopaedic procedure that requires boneto be cut. Device 30 a may be particularly useful for use duringorthopedic knee, hip, shoulder and spine procedures. Additionaldiscussion concerning such procedures may be found in U.S. PublicationNo. 2006/0149225, published Jul. 6, 2006, and U.S. Publication No.2005/0090816, published Apr. 28, 2005, which are assigned to theassignee of the present disclosure and are hereby incorporated byreference in there entirety to the extent they are consistent.

As established above, device 30 a of the present disclosure inhibit suchundesirable effects of tissue desiccation, electrode sticking, charformation and smoke generation, and thus do not suffer from the samedrawbacks as prior art dry tip electrosurgical devices. The use of thedisclosed devices can result in significantly lower blood loss duringsurgical procedures. Such a reduction in blood loss can reduce oreliminate the need for blood transfusions, and thus the cost andnegative clinical consequences associated with blood transfusions, suchas prolonged hospitalization.

While a preferred embodiment of the present disclosure has beendescribed, it should be understood that various changes, adaptations andmodifications can be made therein without departing from the spirit ofthe invention and the scope of the appended claims. The scope of theinvention should, therefore, be determined not with reference to theabove description, but instead should be determined with reference tothe appended claims along with their full scope of equivalents.Furthermore, it should be understood that the appended claims do notnecessarily comprise the broadest scope of the invention which theApplicant is entitled to claim, or the only manner(s) in which theinvention may be claimed, or that all recited features are necessary.

All publications and patent documents cited in this application areincorporated by reference in their entirety for all purposes to theextent they are consistent.

Although the present disclosure has been described with reference topreferred embodiments, workers skilled in the art will recognize thatchanges can be made in form and detail without departing from the spiritand scope of the present disclosure.

What is claimed is:
 1. An electrosurgical device to treat tissue in a presence of radio frequency energy and a fluid provided from the device, the device comprising: a distal portion comprising a first electrode tip, a second electrode tip and at least one fluid outlet; the first electrode tip comprising a first electrode having a distal portion with an electrically conductive spherical surface; the second electrode tip comprising a second electrode having a distal portion with an electrically conductive spherical surface; at least one of the first electrode and the second electrode having a blade portion, wherein the first electrode and the second electrode are configured to be electrically coupled to a bipolar power output; the at least one electrode having the blade portion is configured to be electrically coupled to a monopolar power output; and wherein the blade portion extends longitudinally along at least one of the first and the second electrode.
 2. The device of claim 1 wherein: the blade portion extends from a proximal portion to the distal portion of at least one of the first and the second electrode.
 3. The device of claim 1 wherein: the blade portion has a cutting edge.
 4. The device of claim 3 wherein: the cutting edge is an electrosurgical cutting edge.
 5. The device of claim 3 wherein: the blade portion has opposing sides; the blade portion narrows as the opposing sides approach the cutting edge.
 6. The device of claim 5 wherein: at least one of the opposing sides comprises a planar surface.
 7. The device of claim 5 wherein: at least one of the opposing sides comprises a concave surface.
 8. The device of claim 5 wherein: at least one of the opposing sides comprises a convex surface.
 9. The device of claim 1 wherein: the at least one fluid outlet further comprises at least one fluid outlet in fluid communication with the first electrode and at least one fluid outlet in fluid communication with the second electrode.
 10. The device of claim 9 wherein: the at least one fluid outlet in fluid communication with the first electrode is proximal to a distal end of the first electrode; and the at least one fluid outlet in fluid communication with the second electrode is proximal to a distal end of the second electrode.
 11. The device of claim 9 wherein: the at least one fluid outlet in fluid communication with the first electrode is at least partially defined by the first electrode; and the at least one fluid outlet in fluid communication with the second electrode is at least partially defined by the second electrode.
 12. The device of claim 1 wherein: the first electrode is laterally spaced from the second electrode.
 13. The device of claim 1 wherein: the first electrode is carried by a first tubing segment; and the second electrode is carried by a second tubing segment.
 14. The device of claim 13 wherein: the first tubing segment is electrically conductive; and the second tubing segment is electrically conductive.
 15. The device of claim 14 wherein: the electrically conductive first tubing segment is in electrical contact with the first electrode; and the electrically conductive second tubing segment is in electrical contact with the second electrode.
 16. The device of claim 1 wherein: the first electrode is connected at a distal end of a first tubing segment; and the second electrode is connected at a distal end of a second tubing segment.
 17. The device of claim 16 wherein: the first electrode is mechanically joined to the first tubing segment; and the second electrode is mechanically joined to the second tubing segment.
 18. The device of claim 17 wherein: the first electrode is welded to the first tubing segment; and the second electrode is welded to the second tubing segment.
 19. An electrosurgical device comprising: a distal portion comprising a first electrode tip, a second electrode tip and at least one fluid outlet; the first electrode tip comprising a first electrode having a blade portion extending longitudinally along the first electrode; the second electrode tip comprising a second electrode having a blade portion extending longitudinally along the second electrode; each of the first and second electrodes configured to be electrically coupled to a bipolar energy source by first and second bipolar electrical connectors in electrical communication with the first and second electrodes, respectively; and at least one of the first and second electrodes configured to be electrically coupled to a monopolar energy source by a monopolar electrical connector in electrical communication with at least one of the first and second electrodes. 